Implementing Healthy Steps (National Evaluation 1996 Protocol) Meets HHS Criteria

This report focuses on Healthy Steps as implemented in the 1996 evaluation. HHS has determined that home visiting is not the primary service delivery strategy and the model does not meet current requirements for MIECHV program implementation.

Model implementation summary last updated: 2015

The information in this implementation report reflects feedback, if provided, from this model’s developer as of the above date. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the HHS criteria for evidence of effectiveness. Please see the Effectiveness button on the left for more information about any research on the effectiveness of the model, including any version(s) of the model with effectiveness research. Versions of the model that are described in the Adaptations and enhancements section of this implementation report may include (1) versions that were identified by the model’s developer and (2) versions that have been implemented by researchers and have manuscripts that HomVEE rated high or moderate, but that are not supported by the model’s developer.

Materials and forms to support implementation

Service delivery forms

HS specialists logged detailed information on their contact with families, including the services delivered and topics discussed.

Parents received several written materials to inform them about their child’s development and involve them in their child’s care. These materials included, but were not limited to:

  • Child Health and Development Record. This was provided to parents at the beginning of the program and used to record the child’s growth and development, immunizations, and illnesses. It also contained information on developmental milestones and safety.
  • Linkletters. This was a newsletter with information on well-child appointments, mailed to parents before their well-child visit.
  • Parent prompt sheets. These contained questions parents could ask their clinicians.
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Assessment tools

HS specialists periodically assessed each child’s development, either at the home visit or at an office visit, using several standardized tools. Specialists used portions of the Brazelton Neonatal Assessment instrument at the earliest visit, the MacArthur Communicative Development Inventory as language began to emerge, and the Denver Developmental Screening Test on a periodic basis.
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Sites in the HS (national evaluation) followed protocols and other guidance in the training and operations materials. These materials guided specialists and other clinicians on relaying child development, safety, and other recommendations to parents.

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Available languages

All written materials for parents were available in both English and Spanish.
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Fidelity measurement

To ensure sites in the national evaluation followed the written protocols and guidelines consistently, the NPO, along with representatives from the implementation team and The Commonwealth Fund, visited sites twice: between 6 and 9 months after operations began, and approximately 18 months after startup. In addition to site visits, NPO staff obtained information on fidelity through formal and informal telephone calls with sites, and through documentation of technical assistance.
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Fidelity standards

HS sites in the national evaluation followed written protocols and guidelines that described key model elements and the role of the HS specialist. Another manual, Strategies for Change: Child Development in Primary Care for Young Children, guided pediatric clinicians in the HS approach. This manual instructed clinicians on how to individualize care, focus on the whole child and whole family, and build a relationship with families; included information on child safety in the home, breastfeeding, smoking, and maternal depression; and included strategies for creating teachable moments. A third set of HS manuals and other written materials helped to guide site operations and finances, including recommendations for orienting HS specialists to the practice, and example press releases and fact sheets directed toward families. Sites also received a training manual.

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Implementation notes

The information contained on this page was last updated in August 2015.

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